• Timothy R Deer, Nagy Mekhail, David Provenzano, Jason Pope, Elliot Krames, Michael Leong, Robert M Levy, David Abejon, Eric Buchser, Allen Burton, Asokumar Buvanendran, Kenneth Candido, David Caraway, Michael Cousins, Michael DeJongste, Sudhir Diwan, Sam Eldabe, Kliment Gatzinsky, Robert D Foreman, Salim Hayek, Philip Kim, Thomas Kinfe, David Kloth, Krishna Kumar, Syed Rizvi, Shivanand P Lad, Liong Liem, Bengt Linderoth, Sean Mackey, Gladstone McDowell, Porter McRoberts, Lawrence Poree, Joshua Prager, Lou Raso, Richard Rauck, Marc Russo, Brian Simpson, Konstantin Slavin, Peter Staats, Michael Stanton-Hicks, Paul Verrills, Joshua Wellington, Kayode Williams, Richard North, and Neuromodulation Appropriateness Consensus Committee.
• Center for Pain Relief, Charleston, WV, USA.
• Neuromodulation. 2014 Aug 1;17(6):515-50; discussion 550.

IntroductionThe Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society (INS) evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended appropriate clinical applications.MethodsThe NACC used literature reviews, expert opinion, clinical experience, and individual research. Authors consulted the Practice Parameters for the Use of Spinal Cord Stimulation in the Treatment of Neuropathic Pain (2006), systematic reviews (1984 to 2013), and prospective and randomized controlled trials (2005 to 2013) identified through PubMed, EMBASE, and Google Scholar.ResultsNeurostimulation is relatively safe because of its minimally invasive and reversible characteristics. Comparison with medical management is difficult, as patients considered for neurostimulation have failed conservative management. Unlike alternative therapies, neurostimulation is not associated with medication-related side effects and has enduring effect. Device-related complications are not uncommon; however, the incidence is becoming less frequent as technology progresses and surgical skills improve. Randomized controlled studies support the efficacy of spinal cord stimulation in treating failed back surgery syndrome and complex regional pain syndrome. Similar studies of neurostimulation for peripheral neuropathic pain, postamputation pain, postherpetic neuralgia, and other causes of nerve injury are needed. International guidelines recommend spinal cord stimulation to treat refractory angina; other indications, such as congestive heart failure, are being investigated.ConclusionsAppropriate neurostimulation is safe and effective in some chronic pain conditions. Technological refinements and clinical evidence will continue to expand its use. The NACC seeks to facilitate the efficacy and safety of neurostimulation.© 2014 International Neuromodulation Society.

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